Transfusion-Associated Iron Overload as an Adverse Risk Factor for Transplantation Outcome in Patients Undergoing Reduced-Intensity Stem Cell Transplantation for Myeloid Malignancies
Transfusion-Associated Iron Overload as an Adverse Risk Factor for Transplantation Outcome in Patients Undergoing Reduced-Intensity Stem Cell Transplantation for Myeloid Malignancies
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DOI：
10.1159/000187646
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发表时间：
2008-01-01
影响因子：
2.4
通讯作者：
Min, Yoo Hong
中科院分区：
文献类型：
--
作者：
Kim, Yu Ri;Kim, Jin Seok;Min, Yoo Hong
输血相关的铁超载可能是清髓造血干细胞移植的一个重要危险因素。然而，很少有研究评估铁超载在低强度干细胞移植（RIST）中的作用。我们评估了接受RIST治疗的38例髓系恶性肿瘤患者，其中16例有铁负荷，22例无铁负荷。我们使用移植前血清铁蛋白作为铁超载的标志。输血填充红细胞数与移植前血清铁蛋白水平呈正相关（铁超载组为21.5个单位和1578.7 mu g/l，非铁超载组为12个单位和739.3 mu g/l, p < 0.01）。铁超载对嫁接时间和嵌合分析无显著影响（p = 0.71和0.47）。铁超载在治疗相关死亡率（p = 0.94）、静脉闭塞疾病（p = 0.99）、急性和慢性移植物抗宿主病（p分别= 0.58和0.99）方面没有差异。无病生存率和总生存率有显著差异（铁超载组为35.8%和27%，非铁超载组为80.6%和54.6%，p分别= 0.01和0.03）。我们得出结论，输血相关的铁超载是髓系恶性肿瘤的一个不利危险因素。在清髓造血干细胞移植中，根据体外循环铁负荷的临床结果不同。血清铁蛋白水平的连续随访和明智的铁螯合治疗将需要控制铁超载的副作用和改善移植结果。版权所有2008 S. Karger AG，巴塞尔
Transfusion-associated iron overload could be an important risk factor in myeloablative hematopoietic stem cell transplantation. However, few studies have evaluated the effect of iron overload in reduced-intensity stem cell transplantation (RIST). We evaluated 38 patients with myeloid malignancies, 16 with and 22 without iron overload, who received RIST. We used pretransplant serum ferritin as a marker of iron overload. There was a positive correlation between the number of transfused packed red blood cells and pretransplant serum ferritin levels (21.5 units and 1,578.7 mu g/l in the iron overload group vs. 12 units and 739.3 mu g/l in the iron non-overload group; p < 0.01). Engraftment day and chimerism analysis were not affected by iron overload (p = 0.71 and 0.47, respectively). There were no differences in treatment-related mortality (p = 0.94), veno-occlusive disease (p = 0.99), acute and chronic graft versus host disease (p = 0.58 and 0.99, respectively) according to iron overload. There was a significant difference in disease-free and overall survival (35.8 and 27% in the iron overload group vs. 80.6 and 54.6% in the iron non-overload group; p = 0.01 and 0.03, respectively). We conclude that transfusion-associated iron overload is an adverse risk factor in RIST for myeloid malignancies. The clinical outcomes according to iron overload in RIST were different in myeloablative hematopoietic stem cell transplantation. A serial follow-up of serum ferritin level and judicious iron chelation therapy will be needed to manage the side effect of iron overload in RIST and improve transplantation outcomes. Copyright (C) 2008 S. Karger AG, Basel